Integrated Case Manager Nurse

Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well‑being of children. The organization provides primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services, and family resource centers, serving patients and families from across the country.

Job Summary

The Integrated Case Manager (ICM) coordinates transitional care for children and families assigned to a medical team, ensuring safe and efficient discharges. The ICM also performs Hospital Case Manager (HCM) functions as needed.

Essential Functions

• Assess the clinical situation of neonates, infants, toddlers, preschool, school‑age, adolescent, and young adult patients, addressing physical and behavioral needs during transition home or to alternate levels of care.
• Lead the development and management of care‑coordination plans by collaborating with care‑coordination team members, families/caregivers, treating providers, hospitals, community agencies, and other services.
• Attend all patient rounds with the assigned provider team.
• Document acute‑care admissions and length‑of‑stay concerns as avoidable potential denials when InterQual criteria are not met.
• Collaborate with attending providers to discuss differences in level‑of‑care (LOC) assignments, using clinical protocols, algorithms, and pathways when applicable.
• Ensure patients receive appropriate services across the continuum of care and maintain continuity among providers.
• Provide or arrange outreach calls or visits to verify delivery and access to after‑care services.
• Communicate self‑pay and out‑of‑network payer information to the financial clearance department.
• Educate families about outpatient/observation levels of care and potential co‑pays.
• Perform all functions of a Hospital Case Manager, including hospital education and discharge planning.

Qualifications

• Associate’s Degree in Nursing required; Bachelor’s Degree in Nursing preferred.
• Minimum of 2 years of nursing experience.
• 2–3 years of case‑management experience preferred.
• Prior experience in pediatrics, discharge planning, home care, or related child/family care settings preferred.

Knowledge, Skills, and Abilities

• Independent judgment, analytical ability, systems thinking, and high‑level interpersonal communication.
• Ability to collect pertinent clinical information while maintaining rapport with providers.
• Skill in interpreting clinical treatment information to link patients with appropriate providers and resources.
• Expertise in Utilization Management and familiarity with InterQual criteria preferred.
• Proficiency with Microsoft Word, Outlook, Excel, and Internet applications.
• Ability to learn and navigate hospital‑specific programs such as Origami, Epic, and electronic health records.
• Understanding of how healthcare delivery systems impact patients and families.
• Knowledge of patient care, case‑management theory, and practice preferred.

Licenses and Certifications

• RN – Registered Nurse (Wisconsin State license required).
• CCM – Certified Case Manager (Commission for Case Manager Certification) preferred.